Provider Demographics
NPI:1356670194
Name:GALLAWAY, KRISTEN LADONNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LADONNA
Last Name:GALLAWAY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 MANCHACA RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-6212
Mailing Address - Country:US
Mailing Address - Phone:512-292-1066
Mailing Address - Fax:512-292-4144
Practice Address - Street 1:9801 MANCHACA RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-6212
Practice Address - Country:US
Practice Address - Phone:512-292-1066
Practice Address - Fax:512-292-4144
Is Sole Proprietor?:No
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42753183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist